Friday, January 30, 2009

Here is a comment on the blog. It was great for a lot of reasons....Read it and we can talk about it.

Our business is doing better than ever, making more than ever, and we are fortunately not feeling the pinch (except for those retirement funds...) But in saying that, or when people ask, "How's business?" I feel guilty being honest, because I think a lot of people are hurting, out of work, etc. It's tough for those hard working people who are laid off because of company cuts, etc. I just hope the people going to the Superbowl and buying new cars have the money and are not running up more credit. Problem is, we've allowed too much debt out there and many people don't know how to live within (or below) their means, and they don't know how to save. Sad, but true.The first part of this was his/her business is doing great. Sure things not as good as they use to be but every business is not spinning around the toilet bowl. I have never been a "conspiracy theory" kind of guy but I think it has a lot to do with the media. I think the only thing that matters in the statistics of the whole thing is Consumer Confidence. No one is confident right now. Because some people have lost their jobs but others haven't and they are scared to death to spend any of it.

The next thing the commentor says is that he feels guilty saying things are great. I think it is okay to tell people that things are great when everyone else is good. But when everyone else is crappy it is hard to tell them you are good. Of course, when the media is saying how crappy it is out there and you are doing fine...you feel guilty. I feel the same way. Are things great here? No, but they aren't terrible.

I am always trying to get the pulse of my patients by asking how they are doing. I ask, how are the kids? How is business? How's that car you got last year? You know things like this.I had a couple of guys last week say that work was busy. Not like busy, but busy and I can't handle the volume busy. I had a guy come in yesterday and when I called him to see how the $1000 worth of dentistry I did yesterday was doing he said, "Great, and hey, I want to whiten my teeth and replace some of my old crowns." I said, SURE. But you know things are going that bad for this guy.

I did a root canal on a woman today that had a ring on her finger that was at least 4 carats.While she was getting work done her husband went to the airport to check on his plane.Come to find out that she is a snow bird and lives in Dayton, Ohio. She lives here 4 months out of the year. They own and house in the neighborhood next to my office and they own a golf villa for when their kids want to visit. So some people have money and again they are afraid to spend it.Me, for instance, I don't have a garage on my house. We wanted to do it and not borrow any money to do it. So back in the hey day the project was going to cost $46,000. Just to build a two car garage on our house. Nothing fancy just very expensive.We built the foundation and the driveway ($11,000) and stopped to save more money. We now have the money and it would cost probably 60% less than originally quoted but I am afraid to do it. I am afraid to spend because of what the economy might still bring.

You know we are doing our fourth annual Dentistry from the Heart in a couple of weeks. We usually ask local restaurants to donate food for the volunteers. We ask the local grocery story to donate food so we can grill and feed the patients.This year no one will donate food. The restaurants will not donate platters or anything and the grocery stores will not give us food. Winn-Dixie will NOT donate HOT DOGS. What is a bunch of hot dogs to a grocery store? So is this the store is scared or do they really not have $20 in hot dogs.Even the publicly traded dental supply company, that has helped the past 3 years is balking. Is it really that bad that I have to strong arm my supply company to donate $150 in supplies?

Last thing in the comment...People don't know how to live under their means. Now this might be the best thing that comes out of this "recession". People learning to live with what we make.Now I would like to point the finger elsewhere but my office has never been a real tight ship. We make money and spend it. We make money and then give bonuses. We have saved in the past but at the end of the year we bonuses it out. So now we have to do a lot of creative financing with our bills. I think we lived under our means but only because our we had so much means.Now we don't know how to live on the means we have now.We have all these monitors on the ceiling and cool computer stuff that we bought when it was good.Now a monitor is not working and I have to decide if I want to spend $500 on them coming out and fixing it.I hate being the guy who has the $100,000 car and then complains about the money when he has to get the tires replaced.

Crazy times,I am glad to be sharing it with you guys,Have a great weekend,john

Wednesday, January 28, 2009

Hi all,Sorry about Monday. I was off and didn't feel like doing anything.

Saturday my basketball team had its second game. We played the other 4th grade team from our school. This is a big deal to me because I am 0-4 against the "other team" (football and basketball). It was a tight game, 6-6 after the first, 12-12 at half-time, and 20-22 at the end of the third quarter. But the other team ran in to a buzz saw and we put the smack down on them. 36-24 good guys. The team is really growing up and it is really fun to coach this year. So 2-0. This is big.

Then it was off to Monster Trucks. We start the tailgate at about 4pm (well I did, but the die hards got there at 2pm). It started at 7:30pm and went pretty fast and ended at about 10pm. Okay, let me paint this picture...65,000 monster truck lovin' people, drinking lots of beer and smoking lots of cigarettes. Well did I ever tell you how small my 5 year old's bladder it. And when he has to go, he has to go NOW. So he had to go at about 6pm but he said it was only a Pee. I said, "thank goodness". We waited in line outside of the stadium. We got into the bathroom and let me tell you how disgusting it was. The whole floor of the bathroom was wet. Beer bottles and cans and Pee everywhere. So we get to the urinal and he starts jumping up and down and saying, "Dad, I have to go Poo."WHAT?!!!I said, "Oh no you don't""Yes, I do."We jumped into the stall next to the urinal. Well take a guess what this room looked like. Beer bottles littered all over the thing the toilet looked like someone took a hose to it. Oh and there wasn't any toilet paper. I said, "Noah, you can't go poo right now." "But, daddy I have to go." I told him, he couldn't.So he did okay and just peed. But one hour later and, "I have to go NOW."So I loaded up my pockets with paper towels and we ventured to the bathroom.I will spare you the details but it worked out okay.But besides that we had a ball. My son couldn't stop talking about Grave Digger and Maximum Destruction.

Drip, drip, drip, drip, drip, drip....this is what it is like reading Jane Eyre. I have about 40 pages to go.

Topic....I think about money and how the economy is going. I think about is it really effecting people or is the media really blowing this up. Is it consumer attitude or is it real?Is it people really over spending last year and since things are down a little there whole world is is coming crashing down.I mean I know it is real but....

I want to tell you one more thing first (it is pertinent) before I get started. I told you I went to the Magic game last Thursday night. In the valet parking lot I saw a Bugatti. Now up until last year I have never heard of this kind of car. I knew this car was expensive so I went home and looked it up on the computer. 1.4 MILLION DOLLARS. FOR A CAR. I have not stopped thinking about this. Not about having material things but having something that is worth that much money.

I had a patient last week that spent $16,000 on plastic surgery last year. He also got into his current year Lexus sedan but couldn't afford his nightguard that I recommended for the teeth he was grinding (I charge $575 for a nightguard).

So last night I am at my study club. It was on Stem Cell research. The dentist read a whole bunch of articles before his presentation and made a bunch of calls to companies and the bottom line is it is starting in the field of dentistry.Did you know the highest concentration of medicamal cells are in the dental pulp?This could mean alot down the road. If you harvest pulpal tissue after a kid gets his teeth out after per ortho and later on in his life he has perio disease and he has the cells harvested that can grow bone.....you never know.The problem right now is it is $600 to harvest the cells and $100 a year to save them. I will let you know if I hear anything else.

But one thing about my study club is the diversity of dentists there. I like it because I feel comfortable with these guys and we can talk.I hear one conversation out of the corner of my ear, and it is two guys talking about cars.One guy says he went and test drove an Aston Martin last week. Now this is no Bugatti but it is still a $200,000+ car. Then I looked out in the parking lot and it was a bunch of normal cars. Explorer, Toyota truck, Honda Civic, BMW, Camry.There are a bunch of dentist there that are in different places. It is finally nice for me not to feel inadequate talking to a dude that will spend $200,000+ on a car.

I mean what is going on in this economy. I went to a National Championship game and let me tell you that everyone sitting at the 50 yard line spend more than a $1200 a piece for those tickets. There was 75,000 people willing to drop some serious coin on a weekend.

I went to the Monster Trucks event and there was 65,000 people there dropping $8 a piece for a beer and let me tell you there was some serious beer drinking going on.

So what is real?I got my end of the year statement on my 401k. Talk about real. I lost $80,000 in 9 months. That is real. People are getting let go from their jobs and that is real. I am having to make decisions at the office that I have never had to make and that is real.

But I am pretty sure the SuperBowl is going to be sold out. All the super expensive commercials are going to be watched on everyone's LCD TV.

I was just thinking.How are you doing?How is your office?How is your personal stuff going?Are you feeling the pinch?You can comment and it can be anonymous.

Friday, January 23, 2009

Jan 23rd, 20094 weeks until my 40th birthday. Yeah I said FORTY.It hasn't really hit me yet but I am thinking it is going to suck real bad.I am the kind of guy that still thinks and acts like he is 24.So when I tell someone I am 40 it stings.I am not discontent, but I am halfway home and I think this scares me a little.I don't know.

Anyways....

So I went to the Magic game last night and we got to sit in a skybox.Wow, was that cool.Free food and drinks (well free for me).The Magic though laid a huge egg. It was definitely their worst game of the season.But you know what makes the sting of a loss feel better?You guessed it....Free food and drinks.

I don't know if you saw the Gator Basketball game on Wednesday night.We were up by 7 points with 2 minutes to play and lost. I couldn't sleep Wednesday night, I was so upset. I know what you are thinking and I totally agree with you...I need a sports therapist.

Okay, one last thing before I finish up on Firing Patients.Both my older children need braces bad.The other day they both got palatal expanders.I am sitting in the reception area and a magazine catches my eye.

It was a Cosmopolitan magazine with Jessica Simpson and her big boobs on the cover.The boobs were not the only thing that caught my eye.Here are the headlines on the cover of the magazine."Total Body Sex...These bed shaking techniques will have any man quivering with pleasure from head to toe".Bonus Section....Sexy vs. SwankyThe Trick that Attracts Hot Guys Like Crazy.Your Orgasm Face...what he is thinking when he sees it.The Naked Quiz...use the score to boost your in-the-buff confidence.

I know I have very conservative views, but I don't think I am a prude by any stretch of the imagination.

But to me this is irresponsible on the part of the orthodontist and his staff.This is an orthodontist that sees 50% kids. And how many horny 12-14 year old boys walk through his doors. Not to mention my 9 year old son (Daddy, what is an orgasm face?).I showed this to a couple of my staff members and much to my surprise they were not concerned about this magazine being in the reception area.I was trying to convince them that I thought this was bad.They shrugged their shoulders.I said, "Did you read everything."They said, "Yeah, what is the big deal?"One of them said, "There are alot of adults that come to drop off their kids."I said, "Okay, then have adult magazines like, Southern Living, Consumer Reports, Sports Illustrated, Better Homes and Gardens, any number of the 1000 car magazines.""Well, I guess" she says.The other, "I said you don't have a problem with the stuff on the cover of this magazine?""No" she says."What about if a 9 year old read it?""Wwwwwellllll, I guess, I would have a problem with that". Yeah, this is what I am saying.I have a strict magazine restriction policy at our office. Nothing the kids can't see.I mean I have a family practice. That means families are coming in here. I need to respect the parents of these kids.

Okay firing patients.For me this is kind of a growing process. When I was a young dentist, maybe from years one to nine, I wanted to please everyone. I felt like if things weren't working out it was always my fault. I thought if I ended the relationship there was something I was leaving on the table. There was something I could of done to prevent the deterioration of our relationship. And there was a little issue being that I needed all of my patients.Now it is to a point that I have enough patients and I have come to realize that you can't please everyone.I know this sound like a cliche but it is true. Trust me I have tried to please everyone. It is not possible.Now I realize that I can only do my best. I can only do the things I do. If someone isn't happy, maybe there is something we could of done, but most of the time you can jump through all the hoops and they still are going to be unhappy.I have given money back. I have done so much crap for free. I have overlooked balances. I have rescheduled people that have no business being rescheduled.Now I am not completely healed but I have mostly been healed from this issue.I still make sure we didn't screw up but if someone is unhappy that is okay with me.If they want to leave the practice...it is okay. I can only do so much. I have put people in place to collect money. I have put people in place to greet. I have put people in place to answer the phone and do it well. I have put people everywhere to do the things I can't. I can't be everywhere. I won't micro manage. I can't. I don't have the mental capacity. But the over riding issue is people are just going to be people. Do you think, as good as the Ritz-Carlton is at service that people don't complain. I don't think so. I have been at the counter next to someone that was chewing a poor little desk clerk out at the Ritz one time. I witness another guy go to the counter and complain about his room. They said this was the only room we have. He said to them, "Do you want your people to be happy?""Well yes sir we do". "So I am telling you I am not happy with my room. It is unacceptable"Now we are talking about a Ritz-Carlton. How many unacceptable rooms do you think they have?

Enough.

Have a great weekend.Monster trucks tomorrow. My kids are so excited.john

Wednesday, January 21, 2009

Did I tell you I have a nine year old boy?You all know that this kid is the apple of my eye.But lately his turning from this kid that is all that and a bag of chips to this kid that wants to give us his opinion all the time.I can tell this kid is changing. Not changing like puberty or anything but changing in a way that he is smart enough to know what we say is sometimes different then what he wants.So now it is a bunch of "Why do I have to do that?" or "I don't want to take a shower" or it is just plain, "No".Before this change you could just repeat what you were saying and he would conform. So my wife and I have trained ourselves to either saying things twice (or more) or getting into a discussion about why your way is the better way.So he will take this as, "If I keep them talking, they may tire and give me what I want."So this is the thing that we have been dealing with. He is getting mouthy and just plain sassy.Me, I can handle it. But my wife...it is not so easy with her.It really is a heart issue, but I don't always care about that. Me I just impose my will and maybe the heart will come later. But Hilda's more concerned with the heart and we all know that is the more difficult than just beating him.I will let you know how it goes.

I am plodding through Jane Erye. It is like Chinese torture. Brutal. But I am going to finish the damn thing if it is the last thing I do.

Remember the story a couple of weeks ago when I took the kids to a matinee movie. I took four kids and bought a popcorn and a drink...$50. And I cussed the movie theater for 2 hours.This weekend I took the same kids to the dollar theater to see Madagascar II and bought popcorn and a drink....$13, my kind of theater.

I saw Traitor over the weekend. It was pretty good.I saw the latest Indiana Jones movie...weak at best.

And last but not least WE WON our basketball game. We played a pretty weak team and we beat them 34-12. Oh, yeah. I think it is all coaching.

Okay topic dejour,I say this topic of Firing patients is a tough one. But I would say it is not something I do very often. This topic is fresh in my mind because I had to fire someone a couple of weeks ago. Then just yesterday the FDA magazine came and there was an article on "What is Patient Abandonment?". Then today I get the AGD Impact magazine and it has an article called, "Say, Uncle!"

The main point of the FDA article is to know you patient before you start to work on them.Because there is absolutely no problem with refusing to treat BEFORE you get started.The problem becomes when you start to work and then there is a real problem. The problem is that we, the dentist, only know that patients are crazy AFTER we start working on them. (Now I am using "crazy" as a term of endearment.)After you start to work on them...you have to just suck it up. You can't "fire" a patient if they are in the middle of treatment.You can't refuse to treat someone if they do not have money to pay. If they have a history of not paying or have a balance it doesn't matter.Listen to this from the FDA article (written by an attorney for the FDA)..."As a general rule, the patient's failure to pay will NOT justify the doctor's unilateral termination of the relationship if the patient still needs medical care."Then it goes on to say, "If the patient is under the continuing care of a dentist and has an emergency but is unable to pay at the time of service, the dentist must provide necessary emergency care and decide later whether to pursue the matter of collection."WHAT?!!!The Say, Uncle! article tells of a 42 year old female patient that would get root canals "to relieve pain". After every pulpectomy she would get Lorcet and after every root canal she would get Lorcet. But she never had the money for the restoration. In the end she got root canals on 2,3,5,9, 10,12,13,14,15,21,22,23,24,25,26,27,29,30. I am not going to go into the malpractice stuff but when do you fire this patient.The safe answer is before treatment.One of the PankeyInstitute's sayings is "to know your patient".Trust me, I think I do it right...I do the new patient interview, and I try to establish a relationship with them before we treat. But sometimes I misjudge someone's mental status (if they are crazy or not). I get into treatment with them and it is only a matter of time before I am cursing the day I ever started.

Heres one.I have these two professionals that live and work in my town. One of them misses her New Patient Exam appointment. It is our policy to not call the people that miss this appointment. Our thought process is that if they miss their first appointment with us then...red flag.She called the next day and said her secretary never told her blah, blah, blah. We made her another appointment. We called her previous dentist for her xrays and they told us that she had a problem coming to her appointments.And for the next 4 months with these people it never got any better. She was mean as a snake. She missed about 50% of her appointments. Her husband was very nice and then started missing his appointments. Then they started to run a high bill. Let me just stop for a second and tell you that Apopka is a "small town". I usually bend over backwards to take care of people of influence in community. Do you do this?You want to have a good reputation. You want people to talk well of you. I mean the local attorney is going to come into contact with some people that could appreciate the type of dentistry you give. But it is these people that usually take advantage of your niceness.

Back to the story, once they started running a high bill, he started missing appointments.Their secretary would call and make appointments. We would confirm their appointments with the secretary and when they didn't show up they would blame the secretary.Then the secretary called and asked to pay the bill for them. She started asking questions about their bill. We told her that we were not able to give her this information with out the patient's permission. So we told her to have the patients contact us and give us permission to talk to their secretary about their account.Well, all of sudden he was too busy to call us. Are you kidding me? How difficult can two people be? "YOUR FIRED".

This is getting kinda long.Lets discuss this more on Friday.Have a great one.john

Monday, January 19, 2009

Okay here is the deal.I poured my heart and soul out on this blog on Friday.I know that Friday is usually a weak day for dentist reading blogs.I really wanted some dialogue on this one. So I am printing it AGAIN.If I don't get any responses, I will assume no dentists are reading my blog anymore.I am not that sensitive but...A couple of things before I get to the blog.The Magic...has anyone been watching them. I really think they are the best team in the league, right now. One of my patients asked me if I wanted to go see the Magic play the Celtics on Thursday night....IN A SKYBOX. UH YEAH!!!!The Gator Basketball team has won 10 in a row. Damn it has been a good year and it is only the 19th.There is an outside chance I might (maybe a 10%) one of my patients has a SuperBowl ticket for me.....shh I don't want jinx myself by talking about it.I saw a bunch of movies this weekend but I will tell you about them on Wednesday. You have some reading to do.Oh before I forget...I missed How I Met Your Mother last week but my wife and I caught Worst Week. I was so funny. I think this one is a keeper.

I have been thinking of this topic for a month now.I will get right to it.I had this patient who had a 3 month old and wanted to know if I recommended fluoride supplements.I said, "I don't know. I will make some calls and I have a JADA magazine in the back that is taking about this very subject. I will make the calls and I will read the article and get back to you."I called my friend who is a pediatric dentist.And this is where this story starts getting crazy.I asked him what he does. He says, "I don't recommend fluoride supplements."WHAT?!!!I said, "What do you mean?"He repeated, "I don't recommend fluoride supplements."I asked if this was an AAPD (American Academy of Pediatric Dentists) recommendation or was this your issue.He said, "There is too much concern with Fluorosis to do any recommending."His point was that if they get decay he is there to fix it.If he recommends fluoride and they get Fluorosis he is to blame.He is not saying that he wants them to get decay but his is saying that he doesn't want to be the scapegoat to problems that come with fluoride supplements.I was shocked but I understood his philosophy.As I was still spinning from this conversation I called another pediatric dentist and he didn't say the same thing but I could tell there was also some reservation to giving me a recommendation. He said something like, "I really try to get the parents to start drinking bottled water with fluoride in it."Again, this is getting the kid fluoride but releasing any responsibility.Hmmm?So I went to the article and this is where it all blows up.Okay the article is called Fluoride Supplements, Dental Caries and Fluorosis.I got this out of the JADA magazine Volume 139, November 2008.I am going to give you the cliff notes. This article was basically an articles review. They did an article search from 1966-2006. They found 988 articles. Some of them were repeats. Some of them didn't fit the criteria so basically they widdled it down to 85 articles that were "right on" for what they were looking for.They were looking for if fluoride worked. They were checking in three different age groups.6 months to 3 years, 3 years to 6 years old, then children older than 6.Okay the first sentence I highlighted was...In 2006 (yes, that is two years ago) the Australian Research Centre for Population Oral Health's workshop on the use of fluorides in caries prevention concluded that "fluoride supplements in the form of drops,or tablets to be chewed and/or swallowed should not be used."WHAT??!!!I thought "let me just read some more". So a couple of paragraphs later..."This study (talking about another study) did NOT find statistically significant reduction in caries in permanent teeth."Then a couple of paragraphs later..."The study (talking about yet another study) concluded that "the prenatal fluoride supplements had no benefits."Then it goes on to say that in another study involving 12 year olds that in a five year period there was no significant differences in the kid that took fluoride supplements and the kid that received topical varnish and the kid that just got oral health education.And last but not least, "...expectant mothers used fluoride supplements from the fourth month of pregnancy until the delivery and their children used the supplements until reaching the age of 3 years, showed no caries-preventive benefit."The article was littered with more and more of this.Am I shocking everyone?At this time my head is about to explode.

Then the article goes on to say..."the odds of dental flourosis increased by 84% for each year of use of fluoride supplements between the ages of younger than 6 months and 7 years.

What the heck is going on here?Am I the only one that thought fluoride was good for children.I am the only one that when the kid comes in with alot of decay, I ask the parents where they live.If they live in an area without fluoride in the water they get vitamins with fluoride. I thought everyone was doing this.Don't tell me I am out of the loop again!

The article does go on to say "In permanent teeth, the daily use of supplements prevents dental decay. Okay so what did we learn?Fluoride supplements are not any good from pre-birth to 6 years old. But have a place in preventing decay in permanent teeth. But don't use too much because you can get fluorosis.Last thing....On the front of the article it lists the Clinical Implications to this article. "The current recommendations for use of fluoride supplements during the first six years of life should be re-examined."WELL YEAH!!!Okay, who picks up the ball?Who is responsible to let everyone know?Is it the AGD?Is is the ADA, I mean they published this thing? Is it the AAPD? Is it you?Who? Do we ignore this?Do we brush it under the table? Do we just keep doing what we were doing? Don't rock the boat.I would like to know what you think. Did you know about this?Are you giving supplements?Is this making your head spin?

Friday, January 16, 2009

I have been thinking of this topic for a month now.I will get right to it.

I had this patient who had a 3 month old and wanted to know if I recommended fluoride supplements. I said, "I don't know. I will make some calls and I have a JADA magazine in the back that is taking about this very subject. I will make the calls and I will read the article and get back to you."

I called my friend who is a pediatric dentist. And this is where this story starts getting crazy. I asked him what he does. He says, "I don't recommend fluoride supplements."WHAT?!!!I said, "What do you mean?"He repeated, "I don't recommend fluoride supplements"I asked if this was an AAPD (American Academy of Pediatric Dentists) recommendation or was this your issue.He said, "There is too much concern with Fluorosis to do any recommending."His point was that if they get decay he is there to fix it. If he recommends fluoride and they get Fluorosis he is to blame. He is not saying that he wants them to get decay but his is saying that he doesn't want to be the scapegoat to problems that come with fluoride supplements.I was shocked but I understood his philosophy.

As I was still spinning from this conversation I called another pediatric dentist and he didn't say the same thing but I could tell there was also some reservation to giving me a recommendation. He said something like, "I really try to get the parents to start drinking bottled water with fluoride in it."Again, this is getting the kid fluoride but releasing any responsibility. Hmmm?

So I went to the article and this is where it all blows up. Okay the article is called Fluoride Supplements, Dental Caries and Fluorosis. I got this out of the JADA magazine Volume 139, November 2008.

I am going to give you the cliff notes. This article was basically an articles review. They did an article search from 1966-2006. They found 988 articles. Some of them were repeats. Some of them didn't fit the criteria so basically they widdled it down to 85 articles that were "right on" for what they were looking for.They were looking for if fluoride worked. They were checking in three different age groups. 6 months to 3 years, 3 years to 6 years old, then children older than 6.

Okay the first sentence I highlighted was...In 2006 (yes, that is two years ago) the AustralianResearch Centre for Population Oral Health's workshop on the use of fluorides in caries prevention concluded that "fluoride supplements in the form of drops,or tablets to be chewed and/or swallowed should not be used."WHAT??!!!I thought "let me just read some more". So a couple of paragraphs later..."This study (talking about another study) did NOT find statistically significant reduction in caries in permanent teeth."Then a couple of paragraphs later..."The study (talking about yet another study) concluded that the prenatal fluoride supplements had no benefits."Then it goes on to say that in another study involving 12 year olds that in a five year period there was no significant differences in the kid that took fluoride supplements and the kid that received topical varnish and the kid that just got oral health education. And last but not least, "...expectant mothers used fluoride supplements from the fourth month of pregnancy until the delivery and their children used the supplements until reaching the age of 3 years, showed no caries-preventive benefit." The article was littered with more and more of this.

Am I shocking everyone? At this time my head is about to explode.

Then the article goes on to say..."the odds of dental flourosis increased by 84% for each year of use of fluoride supplements between the ages of younger than 6 months and 7 years.

What the heck is going on here?Am I the only one that thought fluoride was good for children. I am the only one that when the kid comes in with alot of decay, I ask the parents where they live. If they live in an area without fluoride in the water they get vitamins with fluoride. I thought everyone was doing this. Don't tell me I am out of the look again?

The article does go on to say "In permanent teeth, the daily use of supplements prevents dental decay.

Okay so what did we learn?Fluoride supplements are not any good from pre-birth to 6 years old. But have a place in preventing decay in permanent teeth.But don't use too much because you can get fluorosis.

Last thing....On the front of the article it lists the Clinical Implications to this article. "The current recommendations for use of fluoride supplements during the first six years of life should be re-examined."WELL YEAH!!!

Okay, who picks up the ball. Who is responsible to let everyone know? Is it the AGD? Is is the ADA, I mean they published this thing? Is it the AAPD? Is it you?Who? Do we ignore this? Do we brush it under the table? Do we just keep doing what we were doing? Don't rock the boat.

I would like to know what you think. Did you know about this?Are you giving supplements?Is this making your head spin?

Let me know,john

ps Think of me tomorrow at 9am...my first basketball game with my 4th graders.I finished Get Smart. Very good. I was pleasantly surprised. I really like Steve Carell.

Wednesday, January 14, 2009

I am going to write about fluoride and what happened to me last month but I have this topic that is in my head that I just have to tell you.

Before I forget, let me update you on my life.

I am 75% the way through Jane Erye. It is not horrible but it is pretty painful. Again, I cringe thinking of a high school boy trying to get through this book. It would be torture.

There are no guns, footballs, punches, explosions, cuss words, naked people....what good is it?

I did see a couple of movies over the break,

Things We Lost in the Fire, with Halle Berry. I got the feeling they were just adding stuff just to make me cry. It was okay. It was good, not great.

I watched Kit Kittredge: An American Girl with the kids and it was pretty good.

I started Get Smart last night and it is very funny, so far.

Basketball is going much better this year. I am coaching 4th grade boys in basketball. Our first game is this weekend so I will let you know if more organization and more fun equates to more W's. Not that it matters.

It is very hard for the kids to play street ball at school everyday and then ask them to run plays at practice. They just want to get it and run with it.

Okay the story.

I have told you in the past that I like to call my patients at night after a procedure.

For the most part this is the biggest bang for your buck of all the things we do. The response is earth shattering.

But if you call enough people at night, as you might expect, there are a lot of stories that come with these calls.

It is like a meter reader. If you are around people's homes enough you are bound to see naked people (and naked people in real life is a lot different than naked people in the movies).

So I call people.

I like to sit down and call people somewhere between 8 and 9pm.

One time I called a woman that was my age. She had two kids and I think at the time was divorced. She was a little caught off guard. She said everything was great.

But the next time she came to the office she asked to speak to my privately. I took her aside and she kind of whispers to me, "Hey you know you called me the other night. I was thinking maybe I didn't pick up your signals. Did you want to go out with me?"

WHAT?!!

I had this woman (maybe she was 45 and at the time I was maybe 33) who was a patient that was very nice.

I called her to see how she was doing. Everything was great but about two years later one of her friends came to us and she told us that her husband wouldn't let her come back to our office. He was very upset that I called his wife. He became so suspicious of us because of the phone call.

This one elderly woman came to the office with an emergency tooth ache. I fixed her up and called her the next day. This is how it went...

I started, "Hi, this is John Gammichia. We met yesterday and I wanted to see how you are doing today."

Now in retrospect I probably should of told her who I was, like "This is DOCTOR John Gammichia and I am the dentist who helped you out with your tooth yesterday." But I didn't.

At this point I don't realize she has no idea who I am.

So she says, "I am in the middle of something right now and I am really busy."

I said, "Okay I will let you get back to whatever you were doing but I was really concerned about how you were doing today."

She is now angry with me and yells into the phone"I said I AM BUSY!!" and hangs up the phone.

Then there is the 15 year old girl that you do a bunch of fillings on. And you call the house thinking you want to talk to the parents because it is real inappropriate for a man to be calling a 15 year old girl. But she answers the phone and you ask her how she is doing. She says fine and then you end the call.

You hang up and say to yourself, "man that was awkward" and you feel a little dirty.

So now, even if the teen ager (boy or girl) answers and I talk to them, I always ask for the parents. I talk to them and tell them why I was calling.

One time, and I remember this because it was so weird.

You know when you meet someone at your office and the both of you have a lot in common. You are close in age. You both are from the same home town. You both went to the same university or you both like the same NFL team. Or you belong to the same gym.

Whatever.

You hit it off. This dude was that dude. He came in for a New Patient Exam.

Then he came back to do some fillings. It was no big deal. But I called him to see how he was doing.

It wasn't cool anymore. I am sure he thought I was a homosexual (not that there is anything wrong with that) because again it was this awkward, "yeah, I am doing fine tonight....but why are you calling".

"I swear I am calling to see how you are doing from your fillings today."

Monday, January 12, 2009

and you are also probably thinking, "He is totally going to write about the game on his blog."

So you knew that this blog was coming.

I mean, how can you think about dentistry at a time like this.

I HAVE to write on the National Championship Game.

So here is my story.

The game was at 8pm.

My friend shows up at our house at 7:30am.

We load up the car with chairs, food, drinks, a little hibachi grill, coals, and cigars. We got the tickets and money (what else do you need).

So here is the plan. Go and tailgate, go to the game, then the six of us would go to my wife's aunt's house after the game and sleep. I have no idea where she lives but I know it is Miami. I have already called her and set it up. She has graciously agreed.

We got to the game at about noon. Perfect. We parked three spaces from the gate in the parking lot. So we are thinking ahead to the mass exodus after the game. Perfect. This lot was across the street from the stadium. About 200 yards.

We set up camp.We had a couple of people meet us there so our group was about 11. We threw the football. We people watched. We told stories about old football games. We drank and smoked cigars (kids don't try this at home, I am a professional).

At about 1:30 two people in the group went on a recon mission to see if there was anything to do around the stadium. They returned with no merchandise and with word that there wasn't much to do. So we stayed. At about 2:30 we fired up the grill and had burgers.

We knew we would leave toward the stadium at about 6pm. So then more stories and more football.

We met new people that were walking by our little camp site.

I don't know why this happens, but these kind of events just really brings out some weird people.

6pm comes and it is time to move. We pack up the car and start our decent to the stadium. It is total chaos. People are drunk out of their minds. Some on excitement and some on booze.

Ticket scalping was everywhere. So for someone who has tickets it is nice to find out how it could of been. I ask people that are looking for tickets how much they are willing to spend... and I got alot of "no more than $300".

Then I start asking people with tickets, "how much are you selling them for?" And they would say, "1". So I guess in scalping lingo...that is $1000. ONE THOUSAND DOLLARS!

This is some recession we are in.

So we get in the stadium at about 7pm.

It is a beautiful site.

This stadium was awesome. As you can see by the picture we are almost in the center of the end zone and you can see everything. The field was in perfect condition. If you look across the field, up top they have a 90 foot jumbo-tron on both sides of the stadium, IN HIGH DEFINITION. It was awesome.

We start to see a lot of people we know. A lot of nervous energy filled the stadium.

The game, as you may know was a real nail biter.

I have one observation about the game. People can not hold their liquor. I being the responsible drinker stopped drinking at about 6pm. But I guess some people did not have an "off" switch.

At Florida Field they don't sell alcohol but here they did. When I tell you there was some people that were wasted, this would be an understatement.

I am talking like people my father's age that couldn't make it up the stairs. The best is when they are holding two full beers and they fall down because they are too drunk to walk up the stairs. More than once did people walk all the way up to my row (17) and realize they were in the wrong section.

The people directly behind me were in their late fifties maybe early sixties. On one of our touchdowns they were hugging and fell on top of my buddy and me. We were knocked into the people in front of us. We turned around and the two of them are still in an embrace laying on our seats, wasted.

So I am going to pay a alot of money for a ticket and go to a game so drunk that I will not be able to enjoy it, or remember it? I mean, come on, grow up. You are at a college football game but you are not still in college.

One of my friends said that there was a girl in the row behind him that was passed out in her chair the whole first half.

And if you didn't hear....WE WON.

(this picture is becoming a tradition. I have one for all the big games).

So then it is fireworks, the speeches, the trophy presentation. The game ended at about midnight and we didn't leave our seats until about 12:50. Then, it was slapping people five outside the stadium and trying to find a freshly printed T-shirt.

We finally made it back to the car for a victory cigar.

Man was it great. One last thing. Remember when I told you I was three spots from the gate at the parking lot. Well they closed this gate. So we turned out parking in the 3rd spot from the end. It took 1 hour just to get out of the parking lot.

So we get on the crowded road at 2:15am. Turns out my wife's aunt lives 35 miles south of the stadium.

One of the guys we were with had to be at work at noon.

You do the math. If everything goes well we get to her house at 3am (so you are thinking, it is going to be 3:30am) and we have to leave her house at 8 to get this guy to work.

All six of us roll into her house smelling of beer and cigars at 3:30am and then leaving at 8am.

I made the decision NOT to go to my family members house. I know she probably cleaned her house and made the beds and probably bought breakfast but....

We went north and started the trip back home.

5:30 rolls around and we are pulling up in the driveway.

I am a wreck.

I am looking and smelling so good I get to sleep in the guest room for the night (I mean morning).

I sleep until about 10:15am. I get a shower and brush my teeth (twice, with flossing and mouthwash and tongue scraping).

I came to the living room and no one was here.

So what else was there to do but to watch the game again.

And I can tell you....It was almost as good the second time.

I hope you are having a good a day as I am.

Talk to you Wednesday. I hope I can make it about teeth (less of course, the Gators win another championship in the meantime)

john

By the way, Tebow announced that he is coming back for his senior season. I hope to repeat this blog next year. The Rose Bowl...has a nice ring to it, doesn't it?

Tuesday, January 6, 2009

14 hours. I leave to go to the National Championship game in 14 hours. Over the break I sold my $350 tickets to one of my patients and I ended up getting better tickets for $175. So more beer money for me.I am so excited. Hey if you are watching the game, look for me. I will be in the orange and blue and I will be wearing a hat with a "F" on it. I have not shaved since the game our South Carolina game. I have been trimming but I have not shaved off all of my facial hair. But after Christmas I have not even trimmed. I feel like I don't want to change any of the MO JO. I look like a dang gorilla and I have to explain to all my patients why I look like a lumber jack. All the men patients say, "Cool" I totally understand. The women would look at me like I was an idiot. (Which I am but...)Did I tell you how excited I was.

Okay so we got a Wii.

I have one word for you ROCKBAND.

Before I get into all this I want to talk about how reflective I was over Christmas.Even my nine year old said out loud, "it is so hard to not love your stuff more than God."Isn't this crazy? Nine years old.We were able to have a great discussion with him.I told him that it becomes a life long struggle.It doesn't end with toy guns and video games. It is the same with adults just with bigger things. Cars, houses, TV's, clothes, gardens, dental practices...etc.

I did get a chance to go to the Capital One Bowl with my boys. I went to a game with Georgia going against Michigan St. I hate Georgia because...well because it is Georgia (and because of the dancing in the end zone thing last year) and I hate Michigan St. because they beat the Gators in 2000 National Championship game in basketball (man do I hold a grudge or what).I just went to the game because I was given tickets and I had nothing to do.But, I was just moved by the grandeur of the whole thing. I was moved by how great it was to be able to root for your team in this huge stadium. We get to put on our colors and drink a bunch of beer (or soda...depending on what camp you come from) and scream and yell when they come running out of the tunnel.I was thinking this is so great. Sports is so great. This country is so great. As four F-14 flew over the stadium. You know the feeling when you sing the national anthem. You get the chills and how I get to the point where I can't sing anymore because I am getting choked up. Blessed. Man, are we blessed.

Okay, Rockband.We got this game a couple days after Christmas.This game is so awesome. Rockband is like Guitar Hero but with the drums and a microphone. So three people can play at the same time. Actually four can play because you can also add a bass guitar to it.This is like hours of fun. Fun for the whole family. Only thing is the songs are not very kid friendly. I mean they are singing about things that they don't understand but the lyrics can get somewhat suggestive. On New Years Eve it was all about Rockband. Turns out just about everyone at our house had played this game before. The Gammichia's were the only one that hasn't ever played.I have one friend that has it at work and can play EVERY song on expert level on the guitar. It was so fun to watch. Girls, guys, young and old we all played. We shot off some fireworks then everyone went back inside to play the game.

I almost forgot. I got a 40' LCD TV for Christmas. The reason this is so awesome is that I have not yet got into the plasma generation. This TV will replace my 27' tube TV that I got in 1993. You all know how much TV I watch and how many movies I watch. Yep they were all on this old TV. Over the break, we put it in and I had the satellite guys come out and give me all the HD channels. OH MY GOSH, it is so AWESOME. I will tell you about it later.

I have to cut this one short because I have had a week that has been so crazy. Here it is 5:30 on Wednesday and I haven't written up a single chart.

Did I tell you I leave for the National Championship game in 13 hours and 30 minutes.Go Gatorsjohn

Monday, January 5, 2009

For me it is a little back to reality. A little back to my comfort zone.

I wake up early and go to something I know, to a place I know.

I know what I am going to do that day. I usually know who I am going to be with that day.

Very unlike what I did for the last two weeks.Last time we talked, I was sick as a dog.

Well I gutted out the last three days of work. I was wearing a mask for three days...you know when you can hear and feel your breath and you are fogging up and your back is sweating.

Man did it suck. I was miserable.

So Friday, Saturday and Sunday I literally sat on the couch and in my bed.

On Sunday my son woke up sick so the two of us went to the Minute Clinic. This is a little clinic in our local grocery store run by the local hospital and a PA or a RN mans it.

Well she deemed me just having a virus and because I was feeling stuffy and generally crappy, she recommended some over the counter meds and something called the Medi-Pot.

Anyone seen this?

Well it is basically a plastic tea kettle that you put in the medicated salt pack and warm water. Now what you are suppose to do with this thing is you put the spout in one nostril and then tilt it up. It is suppose to go in one nostril and right out the other while depositing the medicine that is suppose to break up all your mucous.

The nurse pitched this to me telling me that "Oprah says she loves it."

Now you know I was feeling really crappy when I couldn't wait to get home to do this.

Filled up the little tea pot and poured it into my nose. I have to say that it did exactly what it said it was suppose to do (except for the stuff coming in in the back of my throat...nasty).

I only did it once because what the nurse also recommended was Mucinex and that stuff really works.

So by Tuesday, I was feeling well enough to go outside. Not totally better but well enough to get out of the house.

Now if you are counting that is 6 days of sickness. I wouldn't wish this on anyone.

But now we are talking two days to Christmas and I needed to get out. I willed myself out the door. I wanted to by my wife one more gift so I took the kids and off we went to Bed, Bath and Beyond.

This is all I did for the first 5 days of vacation....one trip to Bed, Bath and Beyond.

I don't know where this came from or what it means but I know that on Christmas Eve we do fish.

My dad and the rest of the local mafia stand in line at the local fish store at 6am to get fresh fish. It is like a mob scene, literally. You are in the store and you hear alot of Italian being spoken and alot of "fugetaboutit".

But at about 10am my father starts cooking and he doesn't stop until we sit down at about 5pm.

First is conch. Then, fried shrimp, scallops, oysters Rockefeller, then there is usually regular old fish, like this year was Sea Bass, and the main course is linguine with a clam sauce (I know that is only six but I must have forgotten one).

It is a great night that I look forward to every year. It is a family tradition to invite people that you know that may not have "family" around. So we always have our family and their friends.

We talk about "old" times and try to start new ones with the kids.

Okay, so it is the whole thing. Wine, the kids table, eating, dessert, stories.

Part of our night is sitting in a big circle and teaming up to play Taboo.

Our family loves this game. My mother is hilarious, my wife and brother are phenomenal.

Like, "This is a thing on your body..." and the other person says, "Belly button". How do they do this?

A good time had by everyone.

Then my family goes home and opens up the only present they are allowed to open.

Every year it is their Christmas pajamas. This is a photo of them under the tree with their new PJ's.

I will tell you all about Christmas Wednesday. I have one word to tell you...Wii.

OMGosh has it revolutionized our house. We don't have to parent anymore. The machine does it for us.

We could go out to dinner and return and the kids would still be in the same stop.

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